Miss Diagnosis: Statistics from Dr. Duh

Saturday, April 18, 2009

Statistics from Dr. Duh

Prior to yesterday we had been told BLA would offer a 99% cure rate for Cushing's. Dr. Duh, believes the rate to be closer to 90%. Of those "uncured" approximately 5% will need further treatment, the other 5% are still producing some cortisol, but not an amount that is worrisome. He spoke about adrenal remnants that can be left behind at surgery; tiny pieces of the adrenals can be missed even with meticulous surgical skills. As an added bonus other endocrine organs can also "learn" to make cortisol. He said he has one patient that he feels was a surgical failure, but she is thrilled because her body has decided to produce only the appropriate amount of cortisol and she no longer needs to take replacement hydrocortisone. If that's not a success I don't know what is!

I like hearing 99%, but I think the new number is more accurate based on patients experiences I know of. I'd like to think BLA will be the end of a long hard road, but realistically, well...I won't be letting my guard down.

1 comment:

judycolbyApril 18, 2009 at 2:50 PM
I want to live in my little world of 99%!!
But like you, I'm not sure I'll ever let my gaurd down.
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Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.